Fetal surgery for congenital hydronephrosis

Fetal surgery is a treatment approach to anatomic lesions which, if left untreated, may be incompatible with life. Diagnosis of conditions amenable to surgical treatment has become possible because of recent advances in ultrasonography. Correction of such lesions may interrupt the pathologic process and enable the infant to live a normal life. Currently, fetal surgical treatment at the University of California, San Francisco, is limited to correction of posterior urethral valve obstruction and ureteropelvic junction obstruction. Two procedures have been used at the university for surgical correction of anomalies of the urinary tract of the fetus: an open technique and a closed technique. The procedures, parental responses to the treatment, and the role of the clinical specialist in the care of patients having this experimental surgery are described.